MEDICARE: BIANKA PASTRANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720624208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANKA PASTRANO

Provider Business Mailing Address
First Line	:	2724 PLEASANT CT
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-7228
Country	:	US
Telephone Number	:	909-562-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 PLEASANT CT
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-7228
Country	:	US
Telephone Number	:	909-562-2849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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Directions to “ BIANKA PASTRANO ” Practice Location

Language	Start Address	Practice Location

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